High-Dose-Rate Electron Total Skin Therapy: A Comprehensive Dosimetric Study on Stanford Technique Publisher



Geraily G ; Hoveidaei A ; Rastjoo A ; Moharramkhani S ; Ameri A ; Jafari F ; Karimi AH
Source: Radiation Measurements Published:2026

Abstract

Total Skin Electron Therapy (TSET), utilizing the Stanford technique, is an established modality for treating cutaneous T-cell lymphoma (CTCL). Although guidelines such as AAPM TG-30 provide general recommendations, center-specific dosimetric validation is essential due to variations in equipment and geometry. Despite CTCL presenting a notable burden across the Middle East and North Africa (MENA), including Iran, TSET has not been widely implemented in the country. Based on the Stanford technique, gantry angle, percent depth dose (PDD), and lateral dose profiles were optimized for implementation of TSET on 6 MeV High-Dose-Rate Electrons (HDRE) of an Elekta Versa HD linear accelerator. Surface dose distribution, photon contamination, and monitor units (MUs) calculations were also assessed. All measurements were performed at a source-to-surface distance (SSD) of 378.5 cm. The optimal gantry angles were found to be 72.9° and 107.1°. The maximum dose appeared at a depth of 6 mm, with uniform dosimetric parameters. Dose profiles confirmed vertical and lateral uniformity within ±3.5% and ±4%, respectively. Thermoluminescent Dosimetry (TLD) showed surface doses ranging from 185.7 to 294.6 cGy, with acceptable variation. Photon contamination was low (0.69%). Average skin dose, body factor, and dose rate were 289.4 cGy, 2.65, and 0.545 cGy/MU, respectively. This study confirms that correctly applying the Stanford technique with 6 MeV HDRE beams can achieve guideline-compliant uniformity and safe skin dose delivery for patients with CTCL. It also supports the wider use of this method in centers with similar clinical setups. © 2026 Elsevier Ltd.